Individual
MRS. JENNIFER RUTH LARSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1515 SAINT FRANCIS AVE, SUITE 150, SHAKOPEE, MN 55379-3387
(952) 403-3399
(952) 403-3390
Mailing address
21195 RADISSON RD, SHOREWOOD, MN 55331-9189
(952) 470-3976
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9789
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
216702600
—
MN
Enumeration date
05/10/2006
Last updated
11/17/2022
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